Abstract

We present a case report of a 49-year-old male with undiagnosed Pinealocytoma, who exhibited features of Parinaud syndrome. The patient presented to our clinic with complaint of diplopia on looking up for the past four months, along with associated headache: Clinical examination revealed upward gaze palsy, convergence retraction nystagmus, and light-near dissociation. Imaging via CEMRI of the brain and orbit revealed a well-defined solid cystic lesion centered in the pineal region, appearing hyperintense on T2, with the cystic component showing suppression on FLAIR and the solid component displaying homogeneous post-contrast enhancement. The pineal gland was not seen separately from the lesion, and the mass effect led to hydrocephalus. A biopsy confirmed the mass as Pinealocytoma. Conclusions: This case highlights the importance of thorough clinical examination and a basic understanding of neuro-ophthalmology anatomy in diagnosing and managing such clinical presentations.